Pneumonia: burden of disease / Carga de enfermedad por neumonía

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Reuniones periódicas de gastroenterología y hepatología con atención primaria. Motivos de consulta / Periodic gastroenterology and hepatology meetings with primary care. Reasons for consultation

Introducción: la presión asistencial, el envejecimiento poblacional y el aumento de enfermedades crónicas incrementan las derivaciones desde atención primaria, pudiendo sobrecargar el sistema sanitario. Se han efectuado diversas intervenciones que intentan mejorar estos aspectos. Objetivos: valorar motivos de consulta más frecuentes de los médicos generales, tanto en consultas compartidas como en sesiones clínicas realizadas conjuntamente con un especialista consultor en atención primaria, en medios urbano y rural, y su repercusión sobre las derivaciones a primeras consultas de gastroenterología. Material y métodos: se efectúa una intervención de tipo fundamentalmente formativo, consistente en reuniones periódicas en dos centros de atención primaria (urbano y rural), con consultas compartidas y sesiones clínicas en relación con pacientes y temas de gastroenterología. El periodo de intervención (dividido en dos subperiodos) se comparó con un periodo control. Resultados: los problemas más comentados corresponden al tracto digestivo inferior, seguido de patología hepática y del tracto digestivo superior. Se encontraron diferencias significativas en la distribución de diagnósticos entre los dos centros en las consultas compartidas. Se detectó un descenso relativo o porcentual de las derivaciones a nivel global en ambos subperiodos, significativo solo en el primero (51,45 %), así como a nivel rural (45,24 %). Conclusión: los motivos de consulta habituales fueron similares en los medios urbano y rural, con cierto predominio del tracto digestivo inferior. La mayoría pueden ser resueltos desde atención primaria, con el apoyo del consultor especialista. Hay repercusión en las derivaciones a las consultas externas de la especialidad, sobre todo a nivel rural (AU)

Introduction: care overload, aging of population, and increased chronic diseases lead to increased referrals from primary care, which may sometimes overload the health system. Thus, different interventions have been carried out attempting to improve these aspects. Objectives: to assess the most frequent causes of consultation of general physicians, both in joint consultations and clinical sessions held jointly with specialist consultant in primary care, in the urban and rural setting, and the influence on referrals to first consultations of gastroenterology. Material and methods: a mainly training type of intervention was carried out, consisting of regular meetings in both urban and rural primary care center, to perform joint consultations and clinical sessions on patients and topics related to the specialty of gastroenterology. The intervention period (divided in two subperiods) was compared with a control period. Results: most reasons for consultation were those corresponding to lower gastrointestinal tract, followed by liver disease and upper gastrointestinal tract. Significant differences were only found in distribution of diagnoses between the two centers in joint consultations. There was a relative (percent) decrease in referrals at the global level in both subperiods, only significant in the first (51.45 %), as well as in rural setting (45.24 %). Conclusion: common consultations motifs were similar in urban and rural settings, with some relevance of lower gastrointestinal tract disease. Most of them can be solved at primary care, with the help of consultant specialist. There is impact on referrals to the outpatient first consultations of gastroenterology, mainly in rural setting (AU)

Periodic gastroenterology and hepatology meetings with primary care. Reasons for consultation.

INTRODUCTION: care overload, aging of population, and increased chronic diseases lead to increased referrals from primary care, which may sometimes overload the health system. Thus, different interventions have been carried out attempting to improve these aspects. OBJECTIVES: to assess the most frequent causes of consultation of general physicians, both in joint consultations and clinical sessions held jointly with specialist consultant in primary care, in the urban and rural setting, and the influence on referrals to first consultations of gastroenterology. MATERIAL AND METHODS: a mainly training type of intervention was carried out, consisting of regular meetings in both urban and rural primary care center, to perform joint consultations and clinical sessions on patients and topics related to the specialty of gastroenterology. The intervention period (divided in two subperiods) was compared with a control period. RESULTS: most reasons for consultation were those corresponding to lower gastrointestinal tract, followed by liver disease and upper gastrointestinal tract. Significant differences were only found in distribution of diagnoses between the two centers in joint consultations. There was a relative (percent) decrease in referrals at the global level in both subperiods, only significant in the first (51.45 %), as well as in rural setting (45.24 %). CONCLUSION: common consultations motifs were similar in urban and rural settings, with some relevance of lower gastrointestinal tract disease. Most of them can be solved at primary care, with the help of consultant specialist. There is impact on referrals to the outpatient first consultations of gastroenterology, mainly in rural setting.

Ocular mucin gene expression levels as biomarkers for the diagnosis of dry eye syndrome.

PURPOSE: To evaluate mRNA levels of the ocular mucins MUC1, MUC2, MUC4, MUC5AC, and MUC7 in conjunctival impression cytology samples from patients with moderate to severe dry eye syndrome (DES) compared with a population of healthy subjects; and to investigate the use of the levels of these mucin genes as biomarkers of DES and subsequently as a potential diagnostic test for DES. METHODS: This prospective study commenced in the year 2000 and ended in the year 2009. Thirty-eight patients with DES and 43 age- and sex-matched healthy subjects completed the initial part of the study. Investigations were repeated at a later stage in 16 healthy subjects and 30 patients with DES, which were used as external validation data. Conjunctival impression cytology was performed in all subjects to test gene expression of ocular mucin genes MUC1, MUC2, MUC4, MUC5AC, and MUC7. Statistical analysis was performed to determine whether there was a difference in the levels of mucin gene expression between the two groups of subjects. Sensitivity and specificity of mucin gene expression for the diagnosis of DES was calculated. RESULTS: Expressions of MUC1, MUC2, MUC4, and MUC5AC (P < 0.0001) were significantly lower in conjunctival epithelium of patients with DES compared with that in normal subjects. These results were replicated in the external control subject and patient groups. MUC1 expression levels demonstrated the greatest sensitivity (83.3%) and specificity (87.5%) among all genes tested. CONCLUSIONS: The data strongly suggest that the expression levels of MUC1 may be used as a diagnostic test in DES for investigational and selective clinical trials.

Retinopathy online challenge: automatic detection of microaneurysms in digital color fundus photographs.

The detection of microaneurysms in digital color fundus photographs is a critical first step in automated screening for diabetic retinopathy (DR), a common complication of diabetes. To accomplish this detection numerous methods have been published in the past but none of these was compared with each other on the same data. In this work we present the results of the first international microaneurysm detection competition, organized in the context of the Retinopathy Online Challenge (ROC), a multiyear online competition for various aspects of DR detection. For this competition, we compare the results of five different methods, produced by five different teams of researchers on the same set of data. The evaluation was performed in a uniform manner using an algorithm presented in this work. The set of data used for the competition consisted of 50 training images with available reference standard and 50 test images where the reference standard was withheld by the organizers (M. Niemeijer, B. van Ginneken, and M. D. Abràmoff). The results obtained on the test data was submitted through a website after which standardized evaluation software was used to determine the performance of each of the methods. A human expert detected microaneurysms in the test set to allow comparison with the performance of the automatic methods. The overall results show that microaneurysm detection is a challenging task for both the automatic methods as well as the human expert. There is room for improvement as the best performing system does not reach the performance of the human expert. The data associated with the ROC microaneurysm detection competition will remain publicly available and the website will continue accepting submissions.

Epidemiology of refractive errors in an adult European population: the Segovia study.

PURPOSE: To determine the prevalence of refractive errors in Segovia, Spain. METHODS: A cohort of 569 subjects was randomly selected in a stratified manner according to gender and age in a cross-sectional, population-based epidemiologic study, the target population of which was urban residents aged 40 to 79 years. All participants underwent an ophthalmic examination that included measurement of visual acuity (VA) and refraction, tonometry, anterior segment biomicroscopy, funduscopy, optic nerve head photography, and visual field testing. Of those, 417 subjects were enrolled who met the inclusion criteria of a phakic right eye and VA over 20/40. The prevalence of spherical errors was assessed after calculating the spherical equivalent and defining myopia as -0.5 diopters (D) or less and hyperopia as +0.50 D or more. The prevalence of astigmatism over 0.50 D was evaluated in minus cylinder form. RESULTS: The estimated prevalences (95% confidence interval) of myopia, hyperopia, and astigmatism, in the population were 25.4% (21.5-29.8%) 43.6% (39-48.4%), and 53.5% (48.7-58.2%), respectively. No significant gender difference was found in the prevalence of any refractive errors. The prevalence of myopia or the mean value did not change significantly with age. The mean hyperopia and the mean astigmatism (p < 0.01 for both) and the prevalence increased with increasing age (p < 0.01 for both). Anisometropia of 1 D or more was present in 12.3% (49/396 subjects). CONCLUSION: More than 60% of the Segovia population over 40 years of age has a refractive error, with 25.4% myopic and 43.6% hyperopic. Astigmatism is present in over half of the population and the types change with age.

Conjunctival mucin mRNA expression in contact lens wear.

PURPOSE: To investigate the influence of the water content in non-ionic hydrogel contact lenses (HCL) on the mRNA levels of human conjunctival mucin genes (MUCs). METHODS: Sixteen healthy subjects with no history of contact lenses wear were selected and randomized into two equal groups. Group 1 subjects wore low water content (38%, Soflens 38) non-ionic HCLs. Group 2 wore high water content (66%, Soflens 66) non-ionic HCLs. Conjunctival impression cytology was applied to the superior bulbar conjunctiva of both eyes before, 6 months, and 1 year after HCL fitting, and 15 days after discontinuation of wearing. Total RNA was isolated, retrotranscribed, and amplified by conventional polymerase chain reaction (PCR) and by quantitative real time PCR to study the mRNA levels of MUCs and to analyze variations during the study period. Time- and HCL-dependent variations in mRNA expression were analyzed using Student's test. RESULTS: From the known MUCs, transcripts from MUC1, MUC2, MUC4, MUC5AC, MUC7, MUC13, MUC15, MUC16, and MUC17 genes were detected in all subjects before HCL fitting. Except for MUC2, the expression of some MUC genes significantly increased whereas others significantly decreased at either the 6- and 12-month period. Statistically significant differences between both HCL groups (p < 0.001) were found in the MUC4, MUC13, and MUC15 mRNA expression after 1 year of wear and after the 15 days without HCL wear. However, these differences were not clearly related to the water content of the lenses. CONCLUSIONS: Low and high water content non-ionic HCLs induced different changes in the mRNA levels of several MUCs, but the water content was not related to the changes. Recovery to basal levels of conjunctival MUC mRNA expression after wearing HCL lenses for a year takes longer than 15 days for some MUCs.

Retinal image analysis based on mixture models to detect hard exudates.

Diabetic Retinopathy is one of the leading causes of blindness in developed countries. Hard exudates have been found to be one of the most prevalent earliest clinical signs of retinopathy. Thus, automatic detection of hard exudates from retinal images is clinically significant. In this study, an automatic method to detect hard exudates is proposed. The algorithm is based on mixture models to dynamically threshold the images in order to separate exudates from background. A postprocessing technique, based on edge detection, is applied to distinguish hard exudates from cotton wool spots and other artefacts. We prospectively assessed the algorithm performance using a database of 80 retinal images with variable colour, brightness, and quality. The algorithm obtained a sensitivity of 90.2% and a positive predictive value of 96.8% using a lesion-based criterion. The image-based classification accuracy is also evaluated obtaining a sensitivity of 100% and a specificity of 90%.

Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study.

INTRODUCTION: Sepsis is a leading cause of admission to non-cardiological intensive care units (ICUs) and the second leading cause of death among ICU patients. We present the first extensive dataset on the epidemiology of severe sepsis treated in ICUs in Spain. METHODS: We conducted a prospective, observational, multicentre cohort study, carried out over two 3-month periods in 2002. Our aims were to determine the incidence of severe sepsis among adults in ICUs in a specific area in Spain, to determine the early (48 h) ICU and hospital mortality rates, as well as factors associated with the risk of death. RESULTS: A total of 4,317 patients were admitted and 2,619 patients were eligible for the study; 311 (11.9%) of these presented at least 1 episode of severe sepsis, and 324 (12.4%) episodes of severe sepsis were recorded. The estimated accumulated incidence for the population was 25 cases of severe sepsis attended in ICUs per 100,000 inhabitants per year. The mean logistic organ dysfunction system (LODS) upon admission was 6.3; the mean sepsis-related organ failure assessment (SOFA) score on the first day was 9.6. Two or more organ failures were present at diagnosis in 78.1% of the patients. A microbiological diagnosis of the infection was reached in 209 episodes of sepsis (64.5%) and the most common clinical diagnosis was pneumonia (42.8%). A total of 169 patients (54.3%) died in hospital, 150 (48.2%) of these in the ICU. The mortality in the first 48 h was 14.8%. Factors associated with early death were haematological failure and liver failure at diagnosis, acquisition of the infection prior to ICU admission, and total LODS score on admission. Factors associated with death in the hospital were age, chronic alcohol abuse, increased McCabe score, higher LODS on admission, DeltaSOFA 3-1 (defined as the difference in the total SOFA scores on day 3 and on day 1), and the difference of the area under the curve of the SOFA score throughout the first 15 days. CONCLUSIONS: We found a high incidence of severe sepsis attended in the ICU and high ICU and hospital mortality rates. The high prevalence of multiple organ failure at diagnosis and the high mortality in the first 48 h suggests delays in diagnosis, in initial resuscitation, and/or in initiating appropriate antibiotic treatment.

Evaluation of spectral ratio measures from spontaneous MEG recordings in patients with Alzheimer's disease.

Alzheimer's disease (AD) is the most frequent form of dementia in western countries. The rise in life expectancy will likely increase its prevalence, since ageing is the greatest known risk factor. Although an early and accurate identification is critical, low diagnostic accuracy is currently reached. Hence, the aim of the present study was to analyse the spontaneous magnetoencephalographic (MEG) activity from 148 channels in 20 AD patients and 21 healthy controls to extract discriminating spectral features. Relative power (RP) was calculated in conventional frequency bands and several ratios were defined to emphasise the differences in its distribution. Both RP values and spectral ratios were transformed with a principal component analysis to summarise information with minimal loss of variability. AD patients showed a significant increase of RP(delta) and RP(theta), along with a decrease of RP(beta) and RP(gamma). The most significant differences were reached by spectral ratios using the beta band. Specifically, we obtained 75.0% sensitivity, 90.5% specificity and 82.9% accuracy (linear discriminant analysis with a leave-one-out cross-validation procedure), together with a p-value lower than 0.001 (one-way analysis of variance with age as a covariate) using the [RP(alpha)+RP(beta(1))+RP(beta(2))+RP(gamma)]/[RP(delta)+RP(theta)] ratio. The spectral ratios also showed a higher correlation with the severity of dementia than individual relative power measures. Our results suggest that the spectral ratios could be useful descriptors to help in the AD diagnosis, since they effectively summarise the slowing of the AD patients' MEG rhythms in individual indexes and correlate significantly with the severity of dementia.

Quantitative magnetoencephalography of spontaneous brain activity in Alzheimer disease: an exhaustive frequency analysis.

Quantitative magnetoencephalography (qMEG) was used to investigate differences in the 2 to 60 Hz spectral power, between Alzheimer disease (AD) patients and control subjects. Twenty-two AD patients and 21 age-matched control subjects participated in this study. MEG signal analysis comprised the division of the entire 2 to 60 Hz spectrum in 2 Hz-width subbands. Both the relative power and the contribution of each subband to the correct classification of AD patients and controls were calculated. The relative power in 2 bands comprised between 2 to 4 Hz and 16 to 28 Hz was selected by a restrictive multiple-comparison test, among the entire 2 to 60 Hz spectrum. Using 2 to 4 Hz values it is possible to choose a classification rule with an estimate sensitivity and specificity given by 68% and 76% respectively. Alternatively, when 16 to 28 Hz values are used, it is possible to obtain a better classification rule with an estimate sensitivity and specificity given by 81% and 80%, respectively. To the best of our knowledge, this is the first electroencephalography or MEG study where a so exhaustive analysis of the magneto-electric spectrum has been performed. This study supports the notion that more attention should be devoted to the study of beta band in AD.

High-frequency jet ventilation in interventional bronchoscopy: factors with predictive value on high-frequency jet ventilation complications.

STUDY OBJECTIVE: To evaluate the incidence and impact on clinical outcome of complications observed during high-frequency jet ventilation (HFJV) at interventional bronchoscopy and to identify the perioperative factors that may be associated to an increased incidence of such complications. DESIGN: Observational retrospective, study with an observational prospective validation of the statistically significant associations. SETTING: University hospital. PATIENTS: The retrospective study involved 276 patients who underwent an interventional rigid bronchoscopy during general anesthesia and HFJV. Forty consecutive patients were accrued for the prospective validation group. INTERVENTIONS/MEASUREMENTS: Information recorded included patient medical history and perioperative complications observed at HFJV-managed bronchoscopic procedures and their impact on clinical outcome until hospital discharge. MAIN RESULTS: At least one complication was detected in 38% of retrospective patients and 55% of prospective patients. Most frequent complications were hypercapnia, hypoxemia, and hemodynamic instability, but just one case of barotrauma in the retrospective group. Despite the high incidence, these complications were transient and did not increase hospital stay, whereas technical failure to widen airway lumen was associated with an adverse prognosis. Several clinical parameters showed a significant association with complications in the univariate analysis. However, the multivariate analysis only evidenced two independent predictive factors: the ASA physical status scale and baseline oxygen saturation. CONCLUSIONS: Classification in ASA physical status IV group and a baseline oxygen saturation of 95% or less independently predicted the development of complications during interventional rigid bronchoscopy with HFJV.

MEG spectral profile in Alzheimer's disease and mild cognitive impairment.

OBJECTIVE: In this study, we applied a novel procedure to calculate the mean frequency from the Magnetoencephalography (MEG) signals of 22 patients with Alzheimer's Disease (AD), 22 patients with mild cognitive impairment (MCI), and 21 healthy controls. A significant mean frequency decrease was expected in pathological groups. MCI subjects are expected to show intermediate mean frequency values between AD patients and controls. METHODS: MEG signal was obtained from a whole-head 148 channels magnetometer in a resting condition. We estimated the power spectral density from the MEG signal by means of the Fourier transform of the autocorrelation function. Then, we computed the mean frequency for each subject. RESULTS: Mean frequency was higher in controls (12.46 +/- 2.00 Hz, mean +/- SD) than in MCI subjects (10.82 +/- 2.21 Hz) with significant differences (P < 0.05). Moreover, mean frequency values in MCI subjects were higher than in AD patients (9.06 +/- 2.48 Hz, P < 0.05). We also detected a decrease of 0.17 Hz per year in mean frequency from normal subjects' MEG (P < 0.05) CONCLUSIONS: Results demonstrated that the approach adopted for the calculation of a mean frequency score seems to be adequate and sensitive to detect differences between normal aging, cognitive deterioration and AD. In addition, data may contribute to the theoretical discussion on the nature of mild cognitive impairment and its similitudes with Alzheimer's disease. SIGNIFICANCE: This paper may be considered a first step to obtain a reliable measure which summarizes spectral information, and might be of a potential clinical interest.

Automatic image processing algorithm to detect hard exudates based on mixture models.

Automatic detection of hard exudates from retinal images is clinically significant. Hard exudates are associated with diabetic retinopathy and have been found to be one of the most prevalent earliest clinical signs of retinopathy. In this study, an automatic method to detect hard exudates is proposed. The algorithm is based on mixture models to dynamically threshold the images in order to separate hard exudates from background. We prospectively assessed the algorithm performance using a database of 20 retinal images with variable color, brightness, and quality. The algorithm obtained a sensitivity of 90.23% and a predictive value of 82.5% using a lesion-based criterion. The image-based classification accuracy is also evaluated obtaining a sensitivity of 100% and a specificity of 90%

[Genotypic resistence in patients infected with HIV and its correlation with therapy]. / Resistencias genotípicas en pacientes con infección por el virus de la inmunodeficiencia humana. Correlación con las pautas terapéuticas empleadas en su tratamiento.

BACKGROUND AND OBJECTIVE: Our goal was to establish the different therapeutic regimens used in our clinical setting, and to determine the prevalence of genotypic resistances in patients under antiretroviral therapy, analyzing the relationship between the appearance of mutations and treatments along with other HIV related variables. MATERIAL AND METHOD: 191 samples from the same number of patients who were on antiretroviral therapy and virological failure were analyzed. Samples were processed by means of the genotypic technique LiPA in order to study the presence of mutations in the reverse transcriptase (RT) and the protease (P) genes. Prescribed therapeutic regimens and epidemiological variables relevant in HIV infection were also analyzed. RESULTS: Overall resistance prevalence was 72.32%. By LiPA, RT mutations were detected in 71.43% of patients, being M184V, T215Y and L41M the most frequent ones. Moreover, P mutations were detected in 59.38% of cases, being V82A, L90M and I84V the most frequent ones. 61.02% of the patients presented one or more mutations against the reverse transcriptase inhibitors included in their treatment. With regard to protease inhibitors, this fact was documented in 28.81% of cases, and in 23.73% of patients receiving both reverse transcriptase inhibitors and protease inhibitors. CONCLUSIONS: Although the analysis of the mutation patterns by LiPA has known limitations, the prevalence of resistances in our study was different from that reported by other authors, being lower in the P gene and higher in the RT one. Of note, a high proportion of patients showed mutations against the drugs included in their prescribed treatment.

Resistencias genotípicas en pacientes con infección por el virus de la inmunodeficiencia humana. Correlación con las pautas terapéuticas empleadas en su tratamiento / Genotypic resistence in patients infected with HIV and its correlation with therapy

FUNDAMENTO Y OBJETIVO: Describir las pautas de tratamiento empleadas en pacientes infectadospor el virus de la inmunodeficiencia humana (VIH) de nuestro entorno asistencial y determinarla prevalencia de resistencias en pacientes en tratamiento antirretroviral, analizando la relaciónentre la aparición de mutaciones con los regímenes terapéuticos junto con otras variables deinterés.MATERIAL Y MÉTODO: Se analizaron 191 muestras de pacientes en fracaso virológico que estabanrecibiendo tratamiento antirretroviral, mediante la técnica de genotipificación LiPA para determinarla presencia de mutaciones en el gen de la retrotranscriptasa (RT) y de la proteasa (P).Se analizaron las pautas de tratamiento recibido, así como las variables relevantes en la infecciónpor el VIH.RESULTADOS: La prevalencia global de resistencias fue del 72,32%. Mediante LiPA se detectaronmutaciones en RT en el 71,43%, y las más frecuentes fueron M184V, T215Y y L41M. La prevalenciade mutaciones en P fue del 53,38%, siendo las V82A, L90M e I84V más frecuentesrespecto a las mutaciones frente a los fármacos incluidos en la pauta de tratamiento de los pacientes.El 61,02% presentaba una o varias frente a los inhibidores de la transcriptasa inversa,el 28,81% para los inhibidores de la proteasa y el 23,73% tanto frente a los primeros como alos segundos.Se constataron 72 combinaciones terapéuticas diferentes; el tratamiento triple fue la modalidadprescrita en el 73,46% de los casos.CONCLUSIONES: Aun con las limitaciones inherentes a la técnica de LiPA, la prevalencia de resistenciasen nuestro estudio fue diferente de la comunicada por otros autores, siendo menor enel gen P y mayor en TI. Una alta proporción de pacientes mostraron mutaciones frente a los fármacosincluidos en su tratamiento

BACKGROUND AND OBJECTIVE: Our goal was to establish the different therapeutic regimens used inour clinical setting, and to determine the prevalence of genotypic resistances in patients underantiretroviral therapy, analyzing the relationship between the appearance of mutations and treatmentsalong with other HIV related variables.MATERIAL AND METHOD: 191 samples from the same number of patients who were on antiretroviraltherapy and virological failure were analyzed. Samples were processed by means of the genotypictechnique LiPA in order to study the presence of mutations in the reverse transcriptase (RT)and the protease (P) genes. Prescribed therapeutic regimens and epidemiological variables relevantin HIV infection were also analyzed.RESULTS: Overall resistance prevalence was 72.32%. By LiPA, RT mutations were detected in71.43% of patients, being M184V, T215Y and L41M the most frequent ones. Moreover, P mutationswere detected in 59.38% of cases, being V82A, L90M and I84V the most frequentones. 61.02% of the patients presented one or more mutations against the reverse transcriptaseinhibitors included in their treatment. With regard to protease inhibitors, this fact was documentedin 28.81% of cases, and in 23.73% of patients receiving both reverse transcriptase inhibitorsand protease inhibitors.CONCLUSIONS: Although the analysis of the mutation patterns by LiPA has known limitations, theprevalence of resistances in our study was different from that reported by other authors, beinglower in the P gene and higher in the RT one. Of note, a high proportion of patients showedmutations against the drugs included in their prescribed treatment

Efficacy of systemic cyclosporine A and amniotic membrane on rabbit conjunctival limbal allograft rejection.

PURPOSE: To evaluate the effect of intramuscular cyclosporine A (CsA) and amniotic membrane (AM) on conjunctival limbal allograft survival in a rabbit model. METHODS: Eighty-two female rabbits (59 New Zealand white rabbits, 23 Dutch pigmented rabbits) were used. The New Zealand white rabbits were divided into 4 treatment groups: group 1 (n=13), conjunctival limbal autograft transplantation; group 2 (n=12), conjunctival limbal allograft transplantation without additional treatment; group 3 (n=18), conjunctival limbal allograft transplantation and human AM; and group 4 (n=16), conjunctival limbal allograft transplantation and systemic CsA (10 mg/kg/day intramuscularly). The 23 Dutch pigmented rabbits were used as limbal stem cell allograft donors. The rejection index, the mean survival time, and the rejection rates were calculated for each group. RESULTS: After 28 days of follow-up, there were no episodes of limbal rejection in groups 1 and 4, whereas the rejection rate was 100% in groups 2 and 3. There was no significant difference in mean survival time of the rejected grafts between groups 2 and 3. CONCLUSIONS: A model of rejection of conjunctival limbal transplantation was developed in the rabbit. Intramuscularly injected CsA effectively prevents limbal allograft rejection. Human AM is not useful for this purpose.

Prevalence of primary open-angle glaucoma in a Spanish population: the Segovia study.

PURPOSE: To determine the prevalence of primary open-angle glaucoma (POAG) in Segovia, Spain. METHODS: We conducted a cross-sectional, population-based epidemiologic study, the target population of which was residents of Segovia, Spain, aged 40 to 79 years. A sample of 569 subjects was randomly selected in a stratified manner according to gender and age groups. All participants underwent a complete ophthalmic examination that included measurement of visual acuity and refraction, tonometry, anterior segment biomicroscopy, funduscopy, stereoscopic photographs of the optic nerve head, and automated white-on-white visual field testing. Two independent observers evaluated the optic nerve photographs and visual fields. The diagnosis of POAG was established when any eye had an open angle and a glaucomatous optic nerve and glaucomatous visual field. The prevalence of POAG in the population was estimated from the prevalence in the complete sample and the patients already diagnosed at the only glaucoma service in the city. RESULTS: The estimated prevalences (99% confidence interval) in the population were, respectively, 2.1% (1.9-2.3%), and 1.7% (1.6-1.8%) for POAG and ocular hypertension. The prevalence of POAG increased with age (P < 0.005) and tended to be greater (P = 0.054) in men (2.4%) than women (1.7%). CONCLUSION: The prevalence of POAG in this Segovia population is 2.1%, similar to that estimated in previous studies performed in predominantly Caucasian populations.

High cord blood IL-10 levels in preterm newborns with respiratory distress syndrome.

BACKGROUND: The development of respiratory distress syndrome (RDS) is closely related to fetal immaturity, although the participation of inflammatory mechanisms also seems to be likely. We previously reported high interleukin-10 (IL-10) levels in cord blood from preterm infants. In the present study, we investigate the possible role of IL-10 and IL-12 in preterm newborns with RDS, a disease that is also closely related to gestational age. PATIENTS AND METHODS: Cord blood levels of IL-10 and IL-12 (p70 + p40) were determined by ELISA in 20 preterm infants who later developed RDS, in 21 preterm infants without RDS and in 31 full term newborns. In 11 patients follow-up samples could be also obtained between 2 and 14 days of life. RESULTS: Preterm infants with RDS showed higher IL-10 (27 vs 10.8 pg/mL; p: 0.0003) and lower IL-12 (188 vs 384; p: 0.002) levels in cord blood than premature infants without RDS and full term newborns (IL-10: 3.2 pg/mL, p: 0.0001; IL-12: 352 pg/mL; p: 0.002). The differences remained statistically significant after correction for the effect of gestational age between both preterm groups. CONCLUSIONS: The results obtained may be related to an immature cytokine response in premature infants, but the IL-12/IL-10 imbalance found in our patients also supports the hypothesis that inflammation plays a role in RDS.

High cord blood IL-10 levels in preterm newborns with respiratory distress syndrome

Background: The development of respiratory distress syndrome (RDS) is closely related to fetal immaturity, although the participation of inflammatory mechanisms also seems to be likely. We previously reported high interleukin-10 (IL-10) levels in cord blood from preterm infants. In the present study, we investigate the possible role of IL-10 and IL-12 in preterm newborns with RDS, a disease that is also closely related to gestational age. Patients and methods: Cord blood levels of IL-10 and IL-12 (p70 + p40) were determined by ELISA in 20 preterm infants who later developed RDS, in 21 preterm infants without RDS and in 31 full term newborns. In 11 patients follow-up samples could be also obtained between 2 and 14 days of life. Results: Preterm infants with RDS showed higher IL-10 (27 vs 10.8 pg/mL; p: 0.0003) and lower IL-12 (188 vs 384; p: 0.002) levels in cord blood than premature infants without RDS and full term newborns (IL-10: 3.2 pg/mL, p: 0.0001; IL-12: 352 pg/mL; p: 0.002). The differences remained statistically significant after correction for the effect of gestational age between both preterm groups. Conclusions: The results obtained may be related to an immature cytokine response in premature infants, but the IL-12/IL-10 imbalance found in our patients also supports the hypothesis that inflammation plays a role in RDS (AU)

Antecedentes: La aparición del Síndrome de Distress Respiratorio (SDR) se relaciona muy estrechamente con la inmadurez fetal aunque también es probable la participación de mecanismos inflamatorios. Previamente hemos publicado niveles elevados de interleucina 10 (IL-10) en sangre de cordón de niños prematuros. Aquí, investigamos el posible papel de la IL-10 e IL-12 en recién nacidos prematuros con SDR, que también se relaciona con la edad de gestación. Métodos y enfermos: Se determinaron los niveles de IL-10 e IL-12 (p70 + p40) en sangre de cordón mediante ELISA en 20 niños prematuros que después desarrollaron SDR, 21 prematuros sin SDR y 31 recién nacidos a término. En 11 casos también pudimos conseguir muestras de sangre del seguimiento entre 2-14 días de vida. Resultados: Los niños pretérmino con SDR presentaron niveles más altos de IL-10 (27 vs 10,8 pg/mL; p: 0.0003) y más bajos de IL-12 (188 vs 384; p: 0.002) en sangre de cordón que los prematuros sin SDR y que los recién nacidos a término (IL-10: 3,2 pg/mL p: 0.0001 y IL-12 352 pg/mL; p: 0.002).Las diferencias siguieron siendo significativas tras la corrección del efecto de la edad de gestación entre los dos grupos de prematuros. Conclusiones: Los resultados obtenidos pudieran relacionarse con una respuesta inmadura de las citocinas en los prematuros, pero el disbalance IL-12/IL-10 encontrado en nuestros pacientes también apoya la hipótesis según la cual la inflamación juega algún papel en el SDR (AU)